For the Benefit of Whom?: Children, Cosmetic Surgery, and Cognitive Disabilities
A Current Moral Issue
Almost 10 million surgical and non-surgical cosmetic procedures were conducted in the United States in 2009 according to the American Society for Aesthetical Plastic Surgery (ASAPS). Cosmetic surgery by definition is “performed to revise or change the texture, configuration, or relationship of contiguous structures of a feature of the body.” Surgical (e.g. liposuction and breast augmentation) and non-surgical procedures (e.g. laser hair removal, Microdermabrasion, and Botulinum Toxin Type A [Botox, Dysport]) contributed to a $10.5 billion U.S. industry in 2009 as people of all backgrounds and ethnicities sought cosmetic alterations (22% were racial and ethnic minorities). According to ASAPS, 160,283 children 18 and under had cosmetic interventions in 2008 (cf. 205,119 in 2007 when the economy was stronger). The range of procedures performed on children spans everything from Botox injections to laser hair removal to more complex procedures such as breast augmentations, nose surgery (rhinoplasty), and Asian eyelid surgery (blepharoplasty). The prevalence of cosmetic surgeries such as “nose jobs, face lifts, and breast augmentations” has generated the industry label psychiatry with a scalpel as many choose the procedures for supposed psychosocial benefits (i.e. raise self-esteem or improve the quality-of-life). These surgeries on children raise moral interest, but it is cosmetic surgery on children with cognitive disabilities that generates particular ethical attention and is significant for several reasons (e.g. the 2006 Ashley case at http://www.npr.org/templates/story/story.php?storyId=6730813). A child with cognitive disabilities most often cannot participate in medical decision-making nor provide informed consent (patient rights), so health care decisions fall primarily upon the shoulders of parents. Medical-ethical questions surface in this context whenever parents make requests for medical treatment in order to cope with non-medical problems in their disabled children. Benefits and risks to both a child and his or her family factor into a decision whether to pursue a cosmetic medical procedure (e.g. cleft lip repair). Many cosmetic procedures, while practical in nature, do not have a clear medical benefit, thus making it difficult to balance risks and benefits (cosmetic procedures are not often conducted on cognitively disabled children). Finally, doctors explore parental motivations and values involved in making cosmetic surgery decisions prior to performing a cosmetic procedure. The entire issue is plainly rooted deeply in core values such as sanctity of life, rights, and justice.
An Ethical Intersection
A beginning point for evaluating the ethical dimensions of cosmetic surgery on disabled children includes developing a clear understanding and application of the sanctity of life (SL) value. A parent is free to consider personal and family values (e.g. SL) as well as a child’s needs when making health care choices. However, a health care decision to conduct cosmetic surgery on a disabled child is not solely a parental one nor is it influenced only by parental SL values. Such a decision typically involves pediatricians, surgeons, social workers, nurses and others who contribute their specific expertise to gain an accurate picture of the risks and benefits. Indeed, both parents and medical experts offer opinions from within their respective values-grids (cf. influential voices in wider culture that deny moral status and personhood [SL] to individuals with cognitive disabilities; cf. also Singer and infanticide for
children with Down Syndrome [rights and justice]; cf. Gomez-Lobo: the disabled have inherent worth). Since a cognitively disabled child cannot participate in decision-making or make an informed choice to pursue or decline a cosmetic procedure, it is incumbent
upon all to consider carefully the individual identity of such a child. All decision makers should take care to respect the dignity of the cognitively disabled child and not to let the cognitive disability (e.g. phrases like “the mind of a 3-year old”) obscure the possibility
that “a child’s bodily development will matter to her in subtle and unforeseen ways”—ways often known by the loving parents.
Implications for a Christian Ethic
The core Christian sanctity of life (SL) value includes the truth that all humans individually bear God’s image (Genesis 1:26-28). It is often especially difficult to see disabled children as individuals when they are often so dependent upon their parents and when parents sometimes become dependent upon a child’s dependencies (See Parens). Parents from time to time view their children as extensions of themselves, but moms and dads do well to remember that each child (including a disabled child) is a unique individual created in
God’s image. Parents (and health care providers) therefore should take extra care to determine whether a child’s body matters to her and influences her identity before seeking to make changes in her body. They also should avoid the temptation to manipulate a child’s
body to conform to their particular notion of being. Christ cared for children individually (e.g. Mark 10:13), healed them (Luke 8: 49-56), and likened the faith of a Kingdom citizen to that of a child (Mark 10:14-16). Churches will demonstrate the theological significance of disabled children and their families by offering tenderly compassionate and inclusive communities that support them.
For Further Reflection and Action
Website: http://my.clevelandclinic.org/services/cosmetic_surgery/hic_cosmetic_surgery_and_birth_defects.aspx. Print resources: Erik Parens, Surgically Shaping Children: Technology, Ethics, and the Pursuit of Normalcy (Baltimore: Johns Hopkins University Press, 2006) and Lainie Freedman Ross, Children, Families, and Health Care Decision Making (Oxford: Oxford University Press, 2002). For broader reflection see: ASAPS main site (http://www.surgery.org/), Medline’s site on plastic and cosmetic surgery
(http://www.nlm.nih.gov/medlineplus/plasticandcosmeticsurgery.html), and the Christian Center for Bioethics and Human Dignity website materials (e.g. http://www.cbhd.org/content/neuroscience-perspective-introduction-ethical-considerations-0 [see E.D. Cook])
Sept. 20, 2010/Larry C. Ashlock/Baptist Center for Global Concerns/www.bc4gc.org
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